Definitions - what does

it all mean?
Seizure

spontaneous
uncontrolled
abnormal brain
activity

Status
Epilepticu
s

Seizure >20 - 30minutes

OR
Multiple seizures frequent
enough to prevent
recovery between
episodes >20-30mins

Epilepsy

tendency to have
spontaneous
uncontrolled
abnormal brain
activity,
resulting in
recurrent
seizures

Tonic Clonic Seizures

Convulsive seizure with tonic phase (stiffening) and clonic movements (jerking)

Before

During

Prodrome
Aura
Sudden onset
Triggers

Tonic Phase: stiffening, loss of consciousness,

falls, cries out

Clonic Phase: convulsion, jerking of arms and

legs

Excessive salivation (drooling or foaming)

Biting of the tongue
Loss of bowel and/or bladder control
No breathing / random breaths
Eye rolling

After

Post-ictal
Drowsy
Confused
Agitated

Pathophysiology
Seizures are caused
by abnormal
synchronised
discharge of many
neurons

Every individual has

a seizure
threshold the level of
excitability at which
neurons will
discharge
uncontrollably

Triggers that push neuron excitation

past the seizure threshold include:

Sleep deprivation
Dru

g
Flickering lights
Infection / metabolic
disturbance

In patients with
epilepsy the seizure
threshold is lowered
and the neurons are
hyperexcitable

Cause
Intracranial
Underlying brain abnormality

Extracranial
Pyrexia

Raised intracranial pressure

- cerebral tumour
- cerebral odema
pregnant - eclampsia

Stroke

Hypoxia

Biochemical
Sodium, Glucose
Calcium, Magnesium
Urate

Drugs
- Prescribed / Recreational
- Intoxication / Withdrawal

- Thrombo-embolic
- Haemorrhagic

Brain infections

Management in PHC

Danger

Look around scene

make sure no
danger

Respon

Check Patient
Respon

A
D

Airway

Patent?
Give airway support if
needed.

RR
O2 stats
give O2

Breathing

Circulation

Disability

Patent?
Give airway
HRsupport if
neededand bleed
IV access
BP
Cap refill

Head injury?
Infection?
Bleeding?
Temperature?

Management of seizures
Stepwise approach
Initial A,B, C, D

Start treating
underlying cause

Benzodiazepine

Phenytoin
Paralysis and
Ventilation

Benzodiazepine - mechanism of
action
If seizure does not resolve after a few minutes give a benzodiazepine

GAB
A

Enhances the inhibitory effect of GABA

Reduces excessive
neuronal firing
Action
Potential

Action
Potential

Benzodiazepines
First line
IV Access

Lorazepam 0.1mg/kg IV (2-4mg bolus repeated after 15 mins)

Diazepam 10-20mg rectally (repeated after 15 mins)

Second line
No Access
Midazolam 10mg buccally (repeated after 15 mins)

Side Effects

sedation
suppressed breathing
hypotension (worse with
IV)

Phenytoin - mechanism of
action
If seizure does not resolve after benzodiazepine start a phenytoin infusion
Infusion
dose
20mg/kg
over 20
minutes

Blocks voltage-sensitive sodium channels

Inhibits excitatory
neuronal
transmission
Na+

Action
Potential

Action
Potential